Malignant pleural effusion (MPE) is a common clinical problem caused by cancers. Pleural effusion can be the first sign of cancer in more than 25% of patients. Lung cancer and breast cancer are the most common cancers that metastasize to the pleura in men and women, respectively. Other cancers, including, but not limited to, lymphomas, ovarian cancer, stomach cancer, and several unknown primary cancers can also lead to MPE. Dyspnea and chest pain are the most common symptoms of MPE along with other symptoms such as a cough, weight loss, anorexia, fatigue, and weakness. Aggravation of these symptoms is closely related to the rate of accumulation of pleural effusion. Treatment options to MPE are determined by the type and extent of the underlying malignancy. The major goals of the treatment are to relieve symptoms, restore functions, improve the quality of life, and minimize the duration of hospital stay and costs. Although some patients can be treated with systemic therapies, most of these treatments are temporary, and MPE would recur soon. Hence, further palliative treatments to effectively control pleural effusions and relieve symptoms are necessary. This review addresses the pathophysiology of MPE and the treatment options for patients with MPE.
Traditional anthropometric measures, including body mass index (BMI), are insufficient for evaluating the risk of hypertension. We aimed to investigate the association between novel anthropometric indices and hypertension risk in a large population in the United States.Forty-five thousand eight hundred fifty-three participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were enrolled. Social demographic information, lifestyle factors, blood biochemical measurements and anthropometric indices, including body weight, body mass index (BMI), waist circumference, waist-to-height ratio (WtHR), conicity index (CI), a body shape index (ABSI), body roundness index (BRI) and lipid accumulation product (LAP) were collected. Multivariable logistic regression and restricted cubic spline were adopted to investigate the associations between hypertension risk and anthropometric indices. We also performed receiver operating characteristic (ROC) curve analyses to further evaluate the discriminatory powers of anthropometric measurements for screening hypertension risk. Moreover, participants were randomly assigned to the training group and the validation group in a ratio of 3 to 1. A nomogram model based on anthropometric measures was established and validated in the training group and validation group, respectively.All of the anthropometric measurements investigated were positively and independently associated with the hypertension risk. Among all anthropometric indices, per-SD increment in ABSI had the highest OR (OR: 3.4; 95% CI: 2.73-4.24) after adjusting for age, sex, race/ethnicity, education, smoking, drinking, diabetes, and eGFR. Moreover, results from restricted cubic splines revealed the non-linear association between anthropometric measurements and hypertension risk. In ROC analyses, CI had superior discriminatory power for hypertension (area under the curve: 0.71; 95% CI: 0.706-0.715; optimal cutoff value: 1.3) compared with other indices. Nomogram model based on age, sex, diabetes, CI and LAP showed favorable predicting ability of hypertension risk with an AUC (95% CI) in training group of 80.2% (79.7-80.6%), and the AUC (95% CI) in validation group was 79.5% (78.3-80.1%). Meanwhile, calibration plot showed good consistency.Anthropometric measurements including BMI, WtHR, CI, ABSI, BRI and LAP are closely associated with hypertension risk in the present study. For better prevention and treatment of hypertension, more attention should be paid to anthropometric indices, especially novel anthropometric indices.
Abstract Background Numerous studies have been focused on the clinical and imaging features among COVID-19 patients positive for SARS-CoV-2, but the data after negative is limited. We aims to describe these features after negative respiratory nucleic acid testing results.Methods From January 31 to February 28, 2020, 51 mild-to-moderate COVID-19 cases (median: 34.0 years and 47.1% male) were retrospectively enrolled. Demographic, clinical, laboratory, and CT imaging data were collected before and after two sequential negative results for respiratory SARS-CoV-2 .Results After negative for respiratory SARS-CoV-2, the clinical symptoms continued to recover and the abnormal imaging were observed for all of the moderate cases. 77.4% of the moderate patients had multi-lobar involvement and lesions were more frequent in the lower lobes. The most common CT imaging manifestations were ground glass opacity (51.6%) and fibrous stripes (54.8%%). Among 12 out of 31 moderate patients with repeated chest CT scan after negative for SARS-CoV-2, 7 patients (58.3%) with ground-glass absorption reduced over 60% within one week, but there were still 4 cases (13.8%) with absorption less than 5%.Conclusions The clinical symptoms and abnormal imaging persisted but continued to recover after negative for respiratory SARS-CoV-2.
Abstract Background The clinical and imaging features of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections that progressed to coronavirus disease 2019 (COVID-19) have been explored in numerous studies. However, little is known about these features in patients who received negative respiratory nucleic acid test results after the infections resolved. In this study, we aim to describe these features in a group of Chinese patients. Methods This retrospective study includes 51 patients with mild-to-moderate COVID-19 (median age: 34.0 years and 47.1% male) between January 31 and February 28, 2020. Demographic, clinical, laboratory, and computed tomography (CT) imaging data were collected before and after two consecutive negative respiratory SARS-CoV-2 tests. Results Following a negative test result, the patients’ clinical symptoms continued to recover, but abnormal imaging findings were observed in all moderate cases. Specifically, 77.4% of patients with moderate COVID-19 exhibited multi-lobar lung involvement and lesions were more frequently observed in the lower lobes. The most common CT imaging manifestations were ground-glass opacities (51.6%) and fibrous stripes (54.8%%). Twelve of the 31 patients with moderate COVID-19 underwent repeated chest CT scans after a negative SARS-CoV-2 test. Among them, the ground-glass opacities decreased by > 60% within 1 week in seven patients (58.3%), but by < 5% in four patients (13.8%). Conclusions Following a positive and subsequent negative SARS-CoV-2 tests, patients with COVID-19 continued to recover despite exhibiting persistent clinical symptoms and abnormal imaging findings.
Objective: To evaluate the rapid diagnostic value of serum novel coronavirus (2019-nCoV) IgM/IgG detection in COVID-19, aiming to further improve the diagnostic and screening system of COVID-19 Methods: Blood samples were collected from 32 patients with COVID-19 (tested positive for 2019-nCoV nucleic acid by RT-PCR and presented with clinical symptoms) and 34 non-COVID-19 patients (tested negative for 2019-nCoV nucleic acid by RT-PCR and clinically confirmed as non-COVID-19 patients) Colloidal gold-based immunochromatography was used for rapid detection of 2019-nCoV IgM/IgG in these samples The sensitivity and specificity of the test, and the correlation of serum 2019-nCoV IgM/IgG with disease course were analyzed Results: Among the 32 COVID-19 patients, nine tested positive for 2019-nCoV IgM with a positive rate of 28 1% (9/32) and 25 positive for 2019-nCoV IgG with a positive rate of 78 1% (25/32) The total positive rate was 84 4% (27/32) Two of the 34 non-COVID-19 patients tested positive for 2019-nCoV IgG with a positive rate of 5 9% (2/34), while none of them was positive for 2019-nCoV IgM The positive rates of serum IgM were 42 9% (3/7), 30 8% (4/13) and 16 7% (2/12) at 10-20 d, 21-30 d and 31-40 d after the patients developed the symptoms of COVID-19, respectively, which showed a decreasing tread with prolonged disease course The positive rates of serum IgG in COVID-19 patients were 57 1% (4/7), 84 6% (11/13) and 83 3% (10/12) at 10-20 d, 21-30 d and 30-40 d after symptom onset The rate showed an increasing trend with prolonged disease course and reached the peak in about 21-30 d Conclusions: Serum 2019-nCoV IgM/IgG detection (using colloidal gold method) had high sensitivity (84 4%) and strong specificity (94 1%) in the diagnosis of 2019-nCoV infection It had a great value in the diagnosis and screening of COVID-19 and could be used as a valuable complementary method to the COVID-19 diagnostic system due to its advantages of flexibility, rapidity and simplicity
This study aims to ascertain the unique metabolic profile of exhaled breath condensate (EBC) samples in pulmonary aspergillosis (PA) patients, and explore their usefulness for the diagnosis of PA.A total of 133 patients were included in the study, including 66 PA patients (invasive pulmonary aspergillosis, n=3; chronic pulmonary aspergillosis, n=60; allergic bronchopulmonary aspergillosis, n=3) and controls (n=67). Ultra high-performance liquid chromatography coupled with high-resolution mass spectrometry(UHPLC-HRMS) was used to analyze EBC samples. Metabolic profiling of EBC samples that were collected from 22 CPA patients at various times during treatment (before treatment, <1 month, 1-2 months, 2-3 months, 3-6 months, and ≥6 months after treatment initiation) were performed using UHPLC-HRMS. Potential biomarkers were evaluated using cluster analysis, Venn diagram and receiver operating characteristic analysis (ROC).A total of 47 metabolites of potential interest were detected in the EBC samples. Further investigation showed that Asperpyrone C, Kotanin, Terphenyllin, Terrelumamide B, and Cyclotryprostatin D could be used as a diagnostic biomarker for PA. The classification between metabolic profiling of EBC samples from PA patients and controls was good with a sensitivity of 100%, specificity 89.6% for patients with PA, respectively. Venn diagram analysis of these biomarker candidates displayed three main types of compounds, which could be used for the further discrimination of aspergilloma and chronic cavitary PA. In addition, antifungal treatment had a limited influence on the value of the EBC results.This metabolomic approach using UHPLC-HRMS could be used as a noninvasive method for the diagnosis of PA.
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